title: Salt or sugar for your injured brain? A meta-analysis of randomised controlled trials of mannitol versus hypertonic sodium solutions to manage raised intracranial pressure in traumatic brain injury.
abstract: BACKGROUND
  Rising intracranial pressure (ICP) is a poor prognostic indicator in traumatic brain injury (TBI). Both mannitol and hypertonic sodium solutions are used to treat raised ICP in patients with TBI.
  
  
  OBJECTIVE
  This meta-analysis compares the use of mannitol versus hypertonic sodium solutions for ICP control in patients with TBI.
  Randomised clinical trials in adults with TBI and evidence of raised ICP, which compare the effect on ICP of hypertonic sodium solutions and mannitol.
  
  
  METHODS
  The primary outcome measure is the pooled mean reduction in ICP. Studies were combined using a Forest plot.
  
  
  RESULTS
  Six studies were included, comprising 171 patients (599 episodes of raised ICP). The weighted mean difference in ICP reduction, using hypertonic sodium solutions compared with mannitol, was 1.39 mm Hg (95% CI -0.74 to 3.53).
  
  
  CONCLUSIONS
  Methodological differences between studies limit the conclusions of this meta-analysis.
  
  
  CONCLUSIONS
  The evidence shows that both agents effectively lower ICP. There is a trend favouring the use of hypertonic sodium solutions in patients with TBI.
authors.affiliation: Emergency Department, Derriford Hospital, Plymouth, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Rickard
authors.affiliation: Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Smith
authors.affiliation: Centre for Biostatistics, Bioinformatics and Biomarkers, Plymouth University, Plymouth, UK.
authors.forename: P
authors.initials: P
authors.lastname: Newell
authors.affiliation: Centre for Biostatistics, Bioinformatics and Biomarkers, Plymouth University, Plymouth, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bailey
authors.affiliation: Emergency Department, Derriford Hospital, Plymouth, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kehoe
authors.affiliation: Emergency Department, Musgrove Park Hospital, Taunton, UK.
authors.forename: C
authors.initials: C
authors.lastname: Mann
mesh_terms: D001930:Brain Injuries / Q000150:complications*; D004234:Diuretics, Osmotic / Q000627:therapeutic use*; D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy* / Q000209:etiology; D007427:Intracranial Pressure / Q000187:drug effects; D008353:Mannitol / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*
chemical_list: D004234:Diuretics, Osmotic; D012462:Saline Solution, Hypertonic; D008353:Mannitol
keywords: Trauma, Head; Treatment